Change management

Change management refers to a systematic approach to adapting to, controlling and effecting change within an organization. In the context of HIT system implementation, Change Management takes into account the engineering and physical process management aspects of installing the new system, as well as the “people” aspects of redesigning organizational and individual work-flow and workers' roles within the new system.

Changing clinical practice to adhere to evolving clinical guidelines, healthcare policy and quality improvement advances is essential to improving patient outcomes. Automated reminders, electronically prescribed medications, medication interaction alerts, and clinical decision support provide an opportunity to improve patient care utilizing technological advances.

Change management is not limited to technological interventions, however, but also accounts for technological interaction with clinicians. Thus, a complete approach to change management must include effective understanding of behavior change theory in order maximize change efficacy.2

Innovation diffusion described by Glanz et al. in 2008 describes the important features of how change is accomplished. It attests that the rate at which change spreads is based upon three principles: the attributes and perception of the innovation, the characteristics and behaviors of the adopters, and the context within which it is introduced.1

Rogers in 2003 described attributes of an innovation which lead to increased change to include relative advantage, compatibility, complexity, trial-ability, and observability. Relative advantage addresses the idea that the innovation improves the current situation. Compatibility encourages that change should remain consistent with previous experience and needs. Complexity describes the perceived difficulty with the application of the change is made. Trial-ability and observability describe the ability to try a change and the ability to observe others utilizing the change prior to its implementation respectively.

The adopters described by Rogers are separated into groups based upon the timing of their decision to accept change: innovators, early adopters, early majority, late majority, and laggards. It is noted that these adopters are placed under a bell curve with the early and late majority adopters falling within one standard deviation of the mean.

The context within which the innovation is introduced is also thought to substantially influence change. As a profession, medicine is filled with complex and nuanced decision making which is presented under time constraint and sometimes with limited background information. Change management strategies in healthcare must wisely reference this context in order to achieve successful implementation.4

References

1. [Implementation of Effective Change Management for Successful Integration of Health Information Technology (HIT) Systems in Hospitals. Pattarin Mekanontchai. 2009. University Of Oregon. http://aim.uoregon.edu/research/ebriefings/eb-mekanontchai.php full text at: http://aim.uoregon.edu/research/pdfs/2009-mekanontchai.pdf]
2. [Formula for Successful HIT Change Management. Scott R. Coplan. January 16, 2009. HIT Project Management. http://www.hitprojectmanagement.com/2009/01/formula_for_successful_hit_cha.html]
3. [Strategies for Success: Clinical HIT Implementation. Barry P. Chaiken, MD, FHIMSS. July/August 2008. Patient Safety & Quality Healthcare. http://www.psqh.com/julaug08/hit.html]

Submitted by Tim Gray